Provider Demographics
NPI:1033655568
Name:BUCKNER, NAQUIELA I (CMA, MFT)
Entity type:Individual
Prefix:
First Name:NAQUIELA
Middle Name:
Last Name:BUCKNER
Suffix:I
Gender:F
Credentials:CMA, MFT
Other - Prefix:
Other - First Name:NAQUIELA
Other - Middle Name:TUSHIA
Other - Last Name:BUCKNER-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:1780 VERNON ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6311
Practice Address - Country:US
Practice Address - Phone:916-782-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC7878101YM0800X
171M00000X
CAAMFT119229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator